Sculpting happiness
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Plastic surgery has changed a great deal over the last two decades. Not just because more men are succumbing to the scalpel, but principally because ordinary people, as well as showbiz personalities, are discovering that they can improve their attitude to life by retouching their physique. And the surgery has become far more subtle. The results are increasingly natural, so that when you see them, you don't think 'pump-it-up lips or 'nose job.' You just see a happy person.

A successful exponent of the new style of plastic surgery is Dr. Ivan Tome de Arruda, who works principally in Milan, Italy. "I've been in Milan for 16 years. I studied plastic surgery in Rio de Janeiro, with further studies at the Pitanguy centre in Rio, Guy's Hospital in London, the University of Turin, and the National Institute of Cancer Research in Milan."

How is the sector progressing in today's economic climate? "It's still one of the few sectors going well today in Italy. Let's face it: image is important whatever you do. Your appearance helps you in contemporary society. In addition, plastic surgery is changing, and more accessible: new techniques have led to a lot of progress. Scarring is minimal. It's no longer necessary to use total anaesthetic. I do facelifts, implants and so forth, with just local anaesthetic and sedation. The patient can return home the same day. This is a great advantage. Previously you were in hospital for three or four days."

I suppose that your best advertising is by word of mouth? "That's right. When I arrived here, I didn't know anyone. Then I started operating on my wife's relatives, friends, friends of friends... and now I have customers arriving from Kazakhstan, Russia, from all over the place. When people are happy with the results, they speak to their friends, and the circle widens."

And now, men are opting for plastic surgery? "Oh yes, definitely. When I arrived, 3% of my customers were men. Today, the proportion is 15%. Men ask for all sorts of things, principally blepharoplasty –operations on the eyelids – liposculpture, nose remodelling and so forth. Amongst women, the type of operation depends on the season. As we move towards summer, my customers ask for breast augmentation and liposculpture, while in the cooler season, it's more about facial remodelling."

And everything takes place here? "No, no! At my studio in Via Fontana, I just do the initial consultations, and a few procedures such as botox and biorevitalization. I do all the surgery in clinics, above all Villa Letizia, Agorà and Matris, in Milan, which are specialized in plastic surgery. This minimizes any risk of infection or other unwanted effects."

What are the risks? "Plastic surgery is a wonderful profession, but we are working with a living material. We are not like artists sculpting in clay, a material that, once it has been shaped, stays that way. We have to deal with many factors, such as scar tissue formation. To take an example, immediately after a blepharoplasty operation, the results may not yet be quite perfect, there may be a bit of fibrosis, and the overall balance of the eyes and their gaze may not be correct. You return to complete normality after about a month. Often, the initial defects are unnoticeable to other people: it's just the patient who is aware of it."

Do you sometimes say to a prospective patient that it would be better not to operate? "Definitely. Yesterday, a young woman came to see me, and she had a small degree of flaccidity in her arms: she wanted liposuction. I looked at her arms, and there was no fat there at all! I said to her that all she needed to do was to work out a bit at the gym to tighten up the tissues."

I suppose that many of your clients are people for whom a good appearance is an important part of their work? "Of course, my clients include showbusiness and TV personalities, but also many ordinary people who aren't entirely satisfied with their appearance: for example, bags under their eyes, flaccidity in their face, that sort of thing. Today, we have gone beyond the 'plastic surgery circus,' women who are obviously products of the surgeon's knife and implants. I prefer a 'natural' plastic surgery, in which the person appears absolutely normal, and not someone who has been facelifted."

Let's talk about the procedure. How do you start? "The patient arrives with the desire to change something in his or her appearance. Actually, many times I help them change this idea. Often, a person may be obsessed with their slightly protruding ears, and they don't notice the enormous bags under their eyes! I can't avoid telling them this, with a lot of diplomacy... I give them some advice on how they can achieve the sort of beauty that they would like. Of course, no-one is obliged to do anything. You may have an enormous nose and live happily with it for your entire life. Other people may have just a slightly aquiline nose, and it worries them. Every time they wake up in the morning, they look in the mirror, and they're unhappy. In the end, my work is curing this sort of anxiety. That's why not everyone needs plastic surgery: on the contrary, just a few people need it, those who feel that sort of need."

Are there noticeable trends in plastic surgery? "Oh yes. One of the latest developments is that people are arriving here from Kazakhstan, Asia and the Far East, in order to 'westernize' their eyes. Some oriental women don't like their natural eye configuration, and would prefer to have a rounder, more open, Western typology. The amazing thing is that some people from Western countries come to me because they want Eastern-type almond-shaped eyes!" (Below, before-and-after images of this type of operation).

And when a patient returns after two or three months, do you sense their increased happiness? "Yes, definitely. A woman who has had breast implants immediately feels reassured by her new profile. It increases her confidence and brings her more social attention. The same thing is true with a facelift. When you see the difference between your old face, with the tissues drawn downwards by the force of gravity, and the new, retoned face, you feel better. The most gratifying thing in our profession is seeing our clients happier."